多学科方法对老年髋部骨折患者术后发病率和死亡率的疗效。

Efficacy of a multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture.

机构信息

Department of Anaesthesiology, Althaia Xarxa Assistencial Universitària de Manresa, C/ Dr. Joan Soler, 1-3, 08243 Manresa, Barcelona, Spain; School of Medicine and Health Sciences, International University of Catalonia (UIC), C/Josep Trueta, s/n., 08195 Sant Cugat del Vallès, Barcelona, Spain.

School of Medicine and Health Sciences, International University of Catalonia (UIC), C/Josep Trueta, s/n., 08195 Sant Cugat del Vallès, Barcelona, Spain; Clinical Research Unit, Althaia Xarxa Assistencial Universitària de Manresa, C/ Dr, Joan Soler, 1-3, 08243 Manresa, Barcelona, Spain.

出版信息

J Clin Anesth. 2019 Mar;53:11-19. doi: 10.1016/j.jclinane.2018.09.029. Epub 2018 Oct 2.

DOI:10.1016/j.jclinane.2018.09.029

PMID:30286380

Abstract

STUDY OBJECTIVE

We evaluated the efficacy of a multidisciplinary approach to reduce postoperative complications and 1-year mortality in patients, undergoing hip fracture surgery and the impact of surgical delay on mortality.

DESIGN

A non-randomized intervention study with a historical control group (CG).

SETTING

During the hospital stay of patients undergoing hip fracture surgery and subsequent follow-up during 12 months post-discharge.

PATIENTS

240 patients undergoing hip fracture surgery were included in the CG. 272 patients were included in the intervention group (IG).

INTERVENTIONS

CG patients received the standard care given at our hospital. Patients in the IG received a new model of multidisciplinary approach to care.

MEASUREMENTS

The following variables were collected: study group, age, gender, ASA physical status, comorbidity, type of fracture, type of anaesthesia, surgical delay, postoperative complications, hospital stay, destination after discharge and postoperative mortality.

MAIN RESULTS

512 patients (CG = 240; IG = 272). Mean age was 83.8 years in CG and 84.9 years in IG. Patients in the IG had a worse health status according to ASA (III-IV: 68.8% vs 51.7%; p < 0.001) and took more drugs (p < 0.001). Surgery was performed within 48 h of admission in 55.1% of patients of the IG (38.3% CG; p < 0.001). Incidence of postoperative complications (67.3% IG vs 76.2% CG p = 0.025) and hospital stay was shorter in the IG (p < 0.001). A surgical delay of >48 h (HR = 0.61; CI95%: 0.42-0.88) and allocation to the IG (HR = 0.64; CI95%: 0.44-0.93) were the protective factors for mortality.

CONCLUSIONS

The multidisciplinary approach could be associated with a decrease in postoperative complications, hospital stay and mortality. Surgical delay may not increase the risk of mortality. The main objective in the management of these patients should be the optimization of their general health status before surgery rather than surgical delay.

摘要

研究目的

我们评估了多学科方法在减少髋关节骨折手术患者术后并发症和 1 年死亡率方面的疗效，并探讨了手术延迟对死亡率的影响。

设计

一项非随机干预研究，设有历史对照组（CG）。

设置

在髋关节骨折手术患者的住院期间，并在出院后 12 个月进行后续随访。

患者

CG 组纳入 240 例髋关节骨折手术患者。IG 组纳入 272 例髋关节骨折手术患者。

干预措施

CG 组患者接受我院常规治疗。IG 组患者接受新的多学科护理模式。

测量指标

收集以下变量：研究组、年龄、性别、ASA 身体状况、合并症、骨折类型、麻醉类型、手术延迟、术后并发症、住院时间、出院去向和术后死亡率。

主要结果

共纳入 512 例患者（CG=240；IG=272）。CG 组平均年龄为 83.8 岁，IG 组为 84.9 岁。根据 ASA 分级，IG 组患者的健康状况较差（III-IV 级：68.8% vs 51.7%；p<0.001），用药更多（p<0.001）。IG 组 55.1%的患者在入院后 48 小时内接受手术（CG 组为 38.3%；p<0.001）。IG 组术后并发症发生率（67.3% vs 76.2%，p=0.025）和住院时间较短（p<0.001）。手术延迟>48 小时（HR=0.61；95%CI：0.42-0.88）和分组到 IG 组（HR=0.64；95%CI：0.44-0.93）是死亡率的保护因素。